3 key interventions to address lagging payer reimbursements
It seems as if commercial payers are doing all they can to keep from reimbursing providers in a timely manner. According to a recent report by Crowe, 31% of claims submitted to commercial payers in the first quarter of 2023 were not paid for at least three months, as compared with 12% of Medicare claims.…
Insights on population health management challenges through the eyes of C-suite leaders
Population health management is at a crossroads, and one key to ensuring its viability is to bolster stakeholder trust in the potential of value-based payment (VBP) models. That was a key takeaway from healthcare executives who took part in a September panel discussion at the 23rd annual Population Health Colloquium, hosted by the Jefferson College…
Medicaid DSH payment cut barely averted as House, Senate pass short-term federal funding
Hospitals received a last-day reprieve from substantial cuts to Medicaid disproportionate share hospital (DSH) payments, with House leaders reversing course Sept. 30 and ushering through a six-week government funding package. Language in the bill ensures a four-year, $32 billion Medicaid DSH cut will not take effect before Nov. 17. Most importantly, the bill bought time…
Susan Dentzer: Is consolidation in healthcare the work of modern-day robber barons — or the result of overdue reengineering?
The most successful industrialists of America’s Gilded Age were often skewered by contemporary critics as being robber barons. A new generation of naysayers wants to recycle the old rhetoric, this time targeting organizations focused on healthcare: The critics’ clear message: Big money is helping healthcare get bigger, and it’s a bad deal all around. Many…
Applying AI to revenue cycle management
Three examples of AI applications in healthcare provide insight into how healthcare providers are using the technology today. The organizations are Auburn Community Hospital in Auburn, New York; Banner Health in Phoenix, Arizona; and Community Medical Centers, based in Fresno, California, Addressing RCM staffing shortages: Auburn Community Hospital Auburn Community Hospital, an independent 99-bed rural…
Update: Medicaid DSH payment cut averted as House, Senate pass short-term federal funding
Note: The headline and lead section of this article were updated Oct. 1 with news of a six-week government funding extension that delays the Medicaid DSH cuts and pays for other healthcare programs. The article originally was published Sept. 28 under the headline, “An $8 billion Medicaid DSH cut is closer to happening as a…
How AI is about to change healthcare
For executives who have lived through the marketing of such technological developments as big data, the cloud and the Internet of Things, the prospect of taking on the latest hot concept, AI, might not be appealing. But ignoring AI and all its variations may be a mistake. Although there are different technology solutions being sold…
CMS pressures states to restore Medicaid coverage for some beneficiaries who have been disenrolled
CMS says a recent edict to state Medicaid programs has partially stanched the ongoing wave of disenrollments in the program, with about 500,000 beneficiaries set to regain coverage they had lost and “many” others protected from disenrollment going forward. As described in a Sept. 21 summary, 29 states plus Washington, D.C., have acknowledged a systemic…
HHS sets new administrative fee to be paid by parties in No Surprises Act independent dispute resolution cases
Oct. 6 update: The lead section of this article was updated where noted with news about the arbitration portal. The administrative fee for taking out-of-network payment disputes to arbitration under the No Surprises Act in 2024 would be significantly lower than it was for much of 2023, but triple the current rate, according to proposed…
Solving the nursing crisis: 3 lessons learned from the COVID-19 experience
Accounts of the nursing shortage may vary in emphasis, but the contours of the crisis are plain: The United States does not have enough nurses to deliver the high quality of patient care that all healthcare organizations are mandated to provide. This challenge is driving healthcare facilities to rethink how they staff themselves in the…